An endoscopic study on the prevalence of the accessory maxillary ostium in chronic sinusitis patients

Abstract

<p class="abstract"><strong>Background:</strong> Chronic maxillary sinusitis is one of the common ENT problems. Accessory maxillary ostium (AMO) has been postulated in many publications to play a role in the development of chronic maxillary sinusitis. AMO is found in the medial wall of maxillary sinus and located in the lateral wall of the nose. It’s been frequently identified in the routine nasal endoscopy. The variations in the location of AMO have been evaluated by nasal endoscopy in live subjects or through cadaver dissections by many authors. This live study is conducted to identify the prevalence of AMO during nasal endoscopic evaluation of chronic sinusitis patients.</p><p class="abstract"><strong>Methods:</strong> 52 adult patients with symptoms of chronic sinusitis attending the ENT outpatient department were selected and subjected to X-ray of the paranasal sinuses and laboratory tests. Nasal endoscopy was done in all patients to identify the presence and location of the AMO and the results presented. </p><p class="abstract"><strong>Results:</strong> In the 52 patients studied the X-ray of the paranasal sinuses showed positive signs of sinusitis in 32 patients (61.5%). During nasal endoscopy in those 32 patients AMO was identified in 20 patients (62.5%).</p><p class="abstract"><strong>Conclusions:</strong> In patients presenting with symptoms of chronic sinusitis, apart from routine X-ray of the para nasal sinus, identification of the AMO during nasal endoscopy provides an additional evidence of obstruction of the natural ostia of the maxillary sinus. This will be valuable information to the surgeon who is contemplating on a surgical treatment to manage the chronic sinusitis.</p><p class="abstract"> </p>

<p>An Endoscopic Study on the Prevalence of Accessory Maxillary Sinus Ostium in Patients with Chronic Rhinosinusitis in Dar es Salaam, Tanzania</p>

“…The maxillary sinus is also known as the Antrum of the Highmore and is the largest of the paranasal sinuses and the most commonly affected in sinusitis. 1 Anatomical variations have been suggested to play a role in the pathogenesis of chronic rhinosinusitis. [1][2][3][4][5] During evolution, Homo sapiens changed to an upright posture and the maxillary sinus ostium also got rotated to a higher position and the sinus lost the advantage of gravitational drainage.…”

“…It has to depend upon the ciliary action and effective ventilation of the nasal cavity to clear the secretions. 1 Mucociliary transport is directed through the natural ostium in the maxillary sinus, and the accessory ostium does not play a role in its physiologic drainage. 4,6 On the contrary, drained mucus may enter into the maxillary sinus through the accessory ostium, and may play a role in the pathogenesis of chronic maxillary rhinosinusitis.…”

“…This phenomenon has been known as "mucus recirculation". 1,4,6 This is why the presence of the accessory ostium may play a role in the pathogenesis of CRS.…”

“…During inspiration, the nasal airflow creates a negative pressure in the nasal cavity which helps in the sinus drainage. 1 When there is a mucosal swelling, the cilia get paralysed, resulting in poor mucus clearance and mucus stasis in the sinus and secondary infection. 2,[5][6][7][8][9] Infection increases the mucosal swelling further and blocks the natural sinus ostium.…”

“…A vicious cycle is formed and the pressure inside the maxillary sinus builds up, which leads to a rupture of the weaker membranous part of the medial wall, facilitating drainage, and an accessory maxillary ostium (AMO) is thus created. 1,6 It has been compared to the perforation of the tympanic membrane in the case of acute otitis media. 2 It is not clearly known whether accessory maxillary ostium (AMO) is acquired or is a congenital anatomical variation as a result of congenital dehiscence of the fontanelles.…”